129 
PATHO 
the folution of the fubftance, more eafily expel it: fo 
that, in early accidents of this fort, the increafe of one 
power feems to relieve in fome meafure the deficiency of 
the other. This, however, can obtain but fora fhort time; 
for the undue excitement of the fecreting veflels muft 
foon induce altered ftates of the gaftric juices ; Hates in 
which of courfe the latter will be deficient in fopie of the 
diflolving qualities. It is impoflible to Hate exactly 
which of, or in what proportion, tliefe powers firft under¬ 
go derangement. It is probable that, while in gluttons 
diftention of mufcular fibres is the firft ftep to diforder, in 
the drunkard the nervous expanfions may be firft injured, 
while the fecreting veflels are difordered by caufes 
which arife from the conftitution at large. Having ftiown, 
however, that thefe powers are all eflentially deranged in 
a manner almoft fimultaneoully, it is of little importance 
to attempt to trace the fubjeCl further: for it does not 
feem that, generally fpeaking, in the earlieft ftage of in- 
digeftion, the vafcular fyftem is materially implicated. 
We except of courfe the affeftion of the ftomach which 
we have noticed in our introduction, chronic gaftritis. - 
We have already endeavoured, on general principles, 
to trace the morbid affeCtions arifing from diforders of 
the alimentary canal: it remains to do fo in detail. We 
have faid that this diforder injures the other parts by 
nervous influence, or by the abforption and local appli¬ 
cation of difeafed blood. There feems every reafon to 
believe, that in indigeftion, when the complaint is not 
very violent or of long Handing, though nervous irri¬ 
tation may arife, the aflimilation of food into healthy 
blood is not materially altered : fo that difeafe traceable 
to indigeftion will in the firft ftages be the mere confe- 
quence of nervous diforder. It is important, as a prac¬ 
tical diftinCtion, thus to know when derangement is 
propagated to remote organs by nervous communication, 
without involving the vafcular fyftem importantly, or 
whether the vafcular fyftem has become deranged in con- 
fequence of the local application of difeafed blood, or a 
continuance of nervous irritation fo long kept up as to 
alter the contractile power of the veflels. The tracing of 
difeafes in this manner appears to us a matter of the ut- 
moft importance ; for it is notorious that many affeCtions 
arife from difturbance in the ftomach and bowels, which 
mimic or refemble idiopathic difeafes of the firft magni¬ 
tude and danger. 
Idiopathic difeafe may after a time be induced by the 
long continuance of the caufe juft mentioned ; but it is 
a practical faCt of the utmoft confequence, that, while in¬ 
flammation, (and that is the moft frequent form of difeafe 
that occurs,) arifing idiopathically, is difficult of fubduc- 
tion, and only to be removed by emptying the blood-vef- 
fels ; the fame aCtion arifing from nervous excitement 
thus propagated, foon fubfides when that excitement is 
withdrawn; and this takes place, though more rarely, 
even in cafes of long Handing; in cafes where the aflimi- 
lative function is deranged, and morbid ftates of the 
fluids are exifting, the removal of thefe ftates being at¬ 
tended with the gradual fubduCtion of the propagated 
difeafe; 
Having detailed the caufes of indigeftion in full in 
our introductory obfervations on this clafs, we (hall now 
proceed to confider the fymptoms of indigeftion, dividing 
it into two ftages. The firft, in which mere difturbance 
of function, the digeftive, and that in flight degree, is 
apparent, and in which the fympathetic difeafes are vary¬ 
ing and unmarked; the fecond, in which that difturbance 
is manifeited in a marked and ferious form, in which the 
vafcular ftruCture feems continually affeCted, and which 
is generally connected with difeafed ftates of the collati- 
tious vifcera. The dependant ailments attached to each 
of thefe ftates will be difcufled under the fame heads. 
This divifion is however merely chofen on account of its 
practical utility, becaufe fome difference of treatment 
both of the local and conftitutional difeafe is neceflary, 
according as the digeftive difturbance is recent or of long 
LOGY. 
Handing ; but, in enumerating the fymptoms of this dif¬ 
order, it muft be confefled that no peculiar fign indi¬ 
cates with certainty or precifion the pafling of diforder, 
or the firft ftage, into that of difeafe, or the fecond; and 
that much careful and in fome meafure original obferva- 
tion is required even after the fulleft defcription on the 
part of the practitioner. 
The fymptoms of the early ftage of indigeftion are 
fuch as arife from chemical changes in the food, and the 
fimpleftchangesin the gaftric fluid: thefe are the evolution 
and eruCtation of various gafeous, oily, acid, or acrid, pro¬ 
ductions. They exift in various degrees ; butare only pre¬ 
fen t, however, during or after a meal; and, when thedi- 
geftion is not in aCtion, littleinconvenience is experienced. 
It appears, however, that the trifling difturbance in the 
function of the ftomach may, for a certain time, produce a 
feeble or otherwife vitiated fecretion, without in any 
other way very fenfibly affeCting the functions of the 
fyftem. People frequently complain of a fenfe of diften¬ 
tion after eating, and flatulent and acid eruCtations, who, 
notwithftanding, enjoy good general health ; and find 
that even thefe fymptoms may be prevented by taking 
lefs food, and that of a more digeftible quality; and, if 
they are prudent in this refpeCt, and the conftitution is 
otherwife found, and not expofed to the effeCts of indo¬ 
lence, and other caufes weakening the nervous fyftem, 
the ftomach will often recover its powers without far¬ 
ther means. The irritating caufes are often, however, 
daily and hourly applied, and leave the ftomach perma¬ 
nently difordered by their frequency. The gaftric juice 
becomes probably fo altered or increafed, or fecreted at 
improper times, as to produce unpleafant fulnefs in the 
ftomach, even during its empty ftate. The bowels, whe¬ 
ther in confequence of the unnatural or undigefted ftate 
of the materia applied to them, whether fympathetically 
affeCted by continuity of ftruCture, or from want of a 
natural ftimulant exifting in the fecretion of the ftomach, 
become deficient or irregular in performing their office. 
Their fecretions likewife fuffer deviations from the 
healthy ftate, and are fcantily produced. The quantity, 
colour, or confiftence, of the faeces, are changed; they 
are occafionally diftended and tenfe, efpecially lome time 
after eating. Difordered fecretions are manifefted in the 
mouth : a clammy tafte is experienced ; and the tongue 
is more or lefs furred, efpecially in the morning. But 
thefe fymptoms, the patient finds, yield to fome mild 
aperient, which, at the fame time, promotes the aCtion of 
the ftomach; and his feelings on the whole differ but little 
from thofe of health. He is raore apt to be thirfty ; his 
appetite is generally more or lefs impaired and variable; 
he complains of his feet being cold ; butftill his ftrength 
and general appearance are but little affeCted ; and he 
feldom thinks it neceflary to pay particular attention to 
fymptoms which appear fo flight, and for the time yield 
fo readily. By degrees, however, they recur more fre¬ 
quently, and begin to be attended with fome depreffion 
of ftrength, which at firft is only occafional. This, in 
general, is the firft thing which ferioufly calls his atten¬ 
tion to the difeafe. The mind, if the difeafe proceed, 
partakes of thefe returns of languor, and the patient at 
length finds it difficult at all times to command his at¬ 
tention, and, upon the whole, that he is not capable of 
his ufual mental efforts. His fleep is difturbed by per¬ 
plexing dreams, and fometimes by fits of night-mare. In 
a large proportion of cafes, however, he enjoys good 
nights, and even thofe who are troubled with dreaming 
and reftleffnefs, often feel more drowfy than ufual. 
He now becomes alarmed, and occafionally feels a degree 
of defpondency. Inftead of thinking too lightly of his 
complaint, he often regards it in the moft ferious point 
of view, and cannot be perfuaded that any thing lei's 
than fome important derangement can produce the 
anxiety and depreffion by which his attention gradually 
becomes wholly engrofled. 
The derangement of the alimentary canal now pro- 
4 duces 
